Low-fat vegan diet can cut liver fat by a third and improve insulin function in adults with type 2 diabetes

From medicalxpress.com

By Physicians Committee for Responsible Medicine 

Adults with type 2 diabetes who followed a low-fat vegan diet for 16 weeks, eating as much as they wanted, with no calorie counting or portion control, lost weight, reduced fat build-up in the liver and abdomen and improved insulin sensitivity and beta-cell function, according to a new clinical trial published in BMJ Open Diabetes Research & Care.

The study, led by researchers at the Physicians Committee for Responsible Medicine in collaboration with the Yale School of Medicine, is the first to simultaneously measure liver fat, muscle fat, visceral fat and tissue advanced glycation end products (AGEs) in a single plant-based dietary intervention in people with type 2 diabetes, offering a more complete picture of how diet reverses the underlying mechanisms that drive the disease.

Credit: Unsplash/CC0 Public Domain

"For years, people with diabetes have been told to count calories and measure portions. This study shows that a simple shift in what you eat—toward vegetables, whole grains, legumes and fruit—can reduce the fat clogging the liver by a third and improve how the pancreas makes insulin, without anyone having to count a single calorie," said Hana Kahleova, M.D., Ph.D., the lead author of the study and director of clinical research at the Physicians Committee for Responsible Medicine.

Key findings include:

• Body weight fell by an average of 6.0 kg (13.2 pounds) (6.6%), driven mainly by loss of fat mass (-4.2 kg (-9.3 pounds)); visceral (abdominal) fat volume dropped by 290 cm³.
• Hepatocellular (liver) lipid content, a key driver of insulin resistance, fell by 33%.
• Tissue accumulation of advanced glycation end products (AGEs), which contribute to insulin resistance and beta-cell damage, decreased significantly.
• Insulin resistance (HOMA-IR) improved, and insulin sensitivity (OGIS and PREDIM) increased.
• Multiple markers of pancreatic beta-cell function improved, including glucose-stimulated insulin secretion, beta-cell glucose sensitivity, rate sensitivity and potentiation factor.
• HbA1c fell by 1.0 percentage point, and total and LDL cholesterol both decreased significantly.
• These changes occurred without a prescribed calorie target; participants were counselled to eat to satiety on a low-fat, plant-based diet (about 75% of calories from carbohydrates, 15% from protein and 10% from fat).

"This research adds to a growing body of evidence that food can work like medicine for people with diabetes. When patients don't have to weigh their portions or track every calorie, healthy eating becomes something they can actually sustain, and that is when we see real, lasting metabolic change," said Kahleova.

More information

Hana Kahleova et al, Changes in ectopic lipids, insulin sensitivity, and beta cell function after a low-fat vegan diet in adults with type 2 diabetes: a 16-week single-arm clinical trial, BMJ Open Diabetes Research & Care (2026). DOI: 10.1136/bmjdrc-2026-006472

https://medicalxpress.com/news/2026-10-fat-vegan-diet-liver-insulin.html

What is ‘Type 3 Diabetes’? Who’s Most at Risk

From newsweek.com

By Claire Dodds

Type 1 and Type 2 diabetes have long been studied by medical experts and are known as the most common types of diabetes.

However, research shows that there may be a third strain of diabetes, one that is particularly affecting certain groups.

In general, diabetes occurs when the body does not produce enough insulin or cells do not respond properly to insulin, leading to high blood sugar levels.

According to experts, patients with Alzheimer's disease may, actually, be experiencing a similar phenomenon, with some medical professionals referring to it as Type 3 diabetes.

"The term 'Type 3 diabetes' reflects the idea that Alzheimer's disease may involve a form of insulin resistance or impaired insulin signalling in the brain," Suzanne Craft, Ph.D., professor of gerontology and geriatric medicine and director of the Alzheimer’s Disease Research Center at Wake Forest University School of Medicine, told Newsweek.

"This differs from Type 1 diabetes, in which an autoimmune process prevents the pancreas from producing sufficient insulin, and Type 2 diabetes, in which the body becomes resistant to insulin and has difficulty regulating glucose metabolism." 

According to the Alzheimer's Society, patients with the condition may become resistant to insulin as their brains change.

"Nerve cells in the brain may become resistant to the effect of insulin. This may lead to the build-up of amyloid and tau proteins in the brain," the society explains.

Seemingly, this risk goes both ways, as diabetes has been suggested to put patients at a higher risk of developing dementia. 

"Some of the strongest evidence comes from large, long-term observational studies showing that adults with Type 2 diabetes have an increased risk of cognitive decline and dementia, including Alzheimer’s disease," Craft told Newsweek.

"There is also growing evidence that the risk begins before diabetes develops: people with prediabetes, insulin resistance and other forms of metabolic dysfunction also appear to be at increased risk."

However, according to the Alzheimer's Society, "it is important to note that diabetes is only a risk factor and does not mean that a person with diabetes will go on to develop dementia."

Jacob Wackerhausen

Often Misdiagnosed

Type 3 diabetes is not a new notion. A 2017 Newsweek article identified Type 3c diabetes as one caused by various types of damage to the pancreas.

"Type 3c diabetes is caused by damage to the pancreas from inflammation of the pancreas (pancreatitis), tumours of the pancreas, or pancreatic surgery," Newsweek reported at the time.

"This type of damage to the pancreas not only impairs the organ's ability to produce insulin, but also to produce the proteins needed to digest food (digestive enzymes) and other hormones."

The research noted that Type 3c diabetes was often misdiagnosed as Type 2 diabetes. However, this diagnosis is unrelated to the presentation of evidence for Type 3 diabetes relating to Alzheimer's disease.

Mitigating Risk

As scientific interest in this phenomenon develops, medical experts advise on a number of ways to mitigate diabetes risk.

"Regular physical activity is one of the most promising lifestyle interventions for reducing the risk of cognitive decline and dementia," Craft continues.

"Maintaining a healthy weight, eating a healthy diet and controlling cardiovascular risk factors such as blood pressure and cholesterol are also important.

"These approaches may be particularly powerful when combined rather than pursued individually."

Diabetes research is constantly changing, bringing to light new information on the treatment and management of this disease.

The idea of a third type of diabetes may have just been getting off the ground a decade ago, but continued research is helping doctors and patients alike learn more about what makes their insulin production systems tick.

https://www.newsweek.com/what-is-type-3-diabetes-whos-most-at-risk-12524607

Eat, Then Exercise—or Exercise First? In Type 1 Diabetes, the Order May Matter

From diabetesincontrol.com

For people with type 1 diabetes, exercise is rarely as simple as choosing a workout and getting started. Food, insulin, glucose trends, and workout intensity can all change what happens next. New research on exercise timing in type 1 diabetes adds another piece to that puzzle. A randomized crossover trial found that glucose responses differed depending on whether exercise occurred in a post-absorptive state or after a meal, when insulin on board was higher. The results suggest that what happens before exercise may be nearly as important as the workout itself.

Why Exercise Timing in Type 1 Diabetes Matters

Exercise can produce very different glucose responses in people with type 1 diabetes. Moderate aerobic activity often lowers glucose because working muscles rapidly use glucose for energy. In contrast, intense intervals can sometimes produce a smaller decline or even a temporary rise as stress hormones increase glucose production.

However, exercise type is only part of the story. The amount of circulating insulin also matters. After a meal and mealtime insulin dose, insulin on board may remain substantial when exercise begins. As a result, muscle glucose uptake can combine with insulin action and create a sharper glucose decline.

This is why the timing of exercise can matter for people with type 1 diabetes. Two identical workouts may produce different glucose patterns depending on their relationship to food and insulin.

The American Diabetes Association notes that glucose responses can vary with starting glucose, exercise intensity, duration, and insulin adjustments. Diabetes in Control has also reviewed how different workouts affect glucose in type 1 diabetes.

What the Randomized Crossover Trial Found

The 2026 randomized crossover trial published in Diabetologia included 20 physically active adults with type 1 diabetes. Each participant completed four 25-minute cycling sessions. Researchers compared high-intensity interval exercise, or HIIE, with continuous moderate-intensity exercise under both post-absorptive and post-meal conditions.

Importantly, the exercise sessions were matched for mechanical load. The interval sessions alternated one-minute bouts at 100% of maximal aerobic power, while continuous exercise was performed at 50%.

Meal state clearly influenced the response. During exercise, capillary glucose fell less in the post-absorptive state than after a meal. Glucose also declined less during HIIE than during continuous moderate exercise. Moreover, the difference between interval and continuous exercise was strongest in the post-absorptive state.

The average glucose change was approximately -0.72 mmol/L during post-absorptive HIIE compared with -1.73 mmol/L during post-absorptive continuous exercise. After a meal, declines were larger at -2.33 mmol/L for HIIE and -2.61 mmol/L for continuous exercise.

Notably, the differences extended beyond the workout. During the following 24 hours, participants spent less time below 3.0 mmol/L after HIIE than after continuous exercise after researchers adjusted for carbohydrate intake and insulin doses. The study abstract is available through PubMed.

Insulin on Board and Exercise Intensity

Why did eating first make such a difference? Insulin on board is a likely contributor.

During the post-meal sessions, participants had higher circulating insulin. Exercise itself increases glucose uptake by working muscles. Therefore, adding significant insulin action can accelerate the movement of glucose out of the bloodstream.

High-intensity intervals create a different hormonal environment. Catecholamines and other counterregulatory hormones can stimulate the liver to release glucose. Consequently, intense exercise may partly offset the glucose-lowering effect seen during steady aerobic activity.

Still, these findings should not be interpreted as evidence that everyone with type 1 diabetes should exercise before eating or switch to HIIT. The study was small, involving only 20 physically active adults. Individual responses can also vary according to insulin delivery method, fitness, starting glucose, previous activity, carbohydrate intake, and automated insulin delivery settings.

For additional background, Diabetes in Control has discussed target glucose considerations around exercise, emphasizing that exercise type and intensity affect planning.

Applying Exercise Timing Research to Everyday Care

The practical message is personalization rather than finding one ideal time to exercise with type 1 diabetes. Clinicians may want to ask patients not only what exercise they perform, but also when they perform it relative to meals and bolus insulin.

CGM data can make these conversations more useful. For example, patients can compare glucose trends during similar workouts performed under different conditions. Recording meal timing, insulin doses, exercise intensity, and glucose direction may reveal repeatable patterns.

Additionally, patients should be aware that a stable glucose level during exercise does not eliminate the possibility of delayed hypoglycaemia. Increased insulin sensitivity can continue after activity, so post-exercise and overnight monitoring may remain important.

Current diabetes guidance emphasizes individualized carbohydrate and medication adjustments because glycaemic responses to physical activity can vary widely. Therefore, insulin changes should not be based on one study or a single workout.

People experiencing repeated exercise-related hypoglycaemia, unexplained hyperglycaemia, or difficulty adjusting insulin around workouts should discuss their patterns with their diabetes care team. Personalized medical guidance can also be found through Healthcare.pro.

Conclusion

For people with type 1 diabetes, when exercise happens can be just as important as the type of activity. Meal state, insulin on board, and workout intensity can interact to produce meaningfully different glucose responses.

In this randomized crossover trial, high-intensity interval exercise produced a smaller glucose decline than continuous moderate exercise, particularly when performed in the post-absorptive state. Meanwhile, exercising after a meal was associated with larger glucose declines across both exercise types.

These findings reinforce a practical lesson: the same workout does not always produce the same glucose response. Tracking exercise timing alongside insulin, meals, and CGM trends may help clinicians and patients develop safer and more predictable exercise strategies.

FAQs

Does exercising after a meal lower glucose more in type 1 diabetes?

In this study, glucose declined more during post-meal exercise than during exercise in the post-absorptive state. However, individual responses can vary considerably.

Is HIIT safer than moderate exercise for preventing hypoglycaemia?

The trial found smaller glucose declines and less time below 3.0 mmol/L after HIIE compared with continuous moderate exercise. However, that does not establish HIIT as universally safer for every person with type 1 diabetes.

Why does insulin on board matter during exercise?

Insulin promotes glucose uptake, while exercising muscles also consume more glucose. When substantial insulin remains active, these effects can combine and increase the likelihood of falling glucose.

Should people with type 1 diabetes exercise before eating?

Not necessarily. The best timing depends on insulin therapy, glucose trends, exercise type, fitness, and individual responses. Changes to insulin or exercise routines should be discussed with a diabetes care professional.

Can glucose fall hours after exercise?

Yes. Exercise can increase insulin sensitivity after a workout, so delayed and overnight hypoglycaemia may occur. CGM monitoring and an individualized management plan can help identify these patterns.

This content is not medical advice. For any health issues, always consult a healthcare professional. In an emergency, call 911 or your local emergency services.

https://www.diabetesincontrol.com/exercise-timing-type-1-diabetes/ 

Type 1 Diabetes - 1 Step Ahead

From testfortype1.com

Think you know Type 1 Diabetes? We’re here to help you understand how it differs from Type 2 Diabetes, who may be at higher risk, how early detection can identify Type 1 Diabetes before symptoms appear, and the research trials currently screening thousands of adults and children across the UK. 

Overview

• Type 1 Diabetes is an autoimmune condition. This means the body’s immune system mistakenly attacks the insulin‑producing cells in the pancreas.
• Insulin is a hormone that helps move glucose from the blood into the body’s cells for energy.
• Over time, as more of these cells are lost, the body can no longer control blood sugar on its own, and insulin injections become necessary.
• T1D often develops slowly and quietly, with no obvious symptoms at first.
• Learning about the condition can help you and your family feel prepared and informed.

Key Facts About Type 1 Diabetes in the UK

• Around 464,000 people in the UK live with Type 1 Diabetes.
• It can develop at any age, but is more commonly diagnosed in childhood or early adulthood. Read who may be at greater risk of T1D
• T1D is an autoimmune condition and is not caused by lifestyle, diet, or personal choices .
• More than 1 in 4 children are diagnosed after developing diabetic ketoacidosis (DKA), a serious complication that needs urgent care. Know the symptoms and complications of T1D

How Does aT1D Develop?

1. Immune system activation

Normally, the immune system protects the body from infections. In T1D, it mistakenly identifies the insulin producing cells as harmful and begins to attack them.

2. Autoimmune progression

This autoimmune process may continue for months or years without symptoms.

3. Declining insulin production

As more insulin producing cells are lost, the pancreas produces less insulin. Blood glucose becomes harder to control naturally.

4. Symptoms emerge

When insulin levels fall too low, symptoms such as thirst, weight loss, tiredness, and needing the toilet more often can start to appear. These are commonly known as the '4Ts' Toilet, Thirsty, Tired, and Thinner.

5. Diagnosis & Lifelong Management

At diagnosis, individuals with T1D may require insulin therapy to maintain safe blood glucose levels and support normal metabolic function.

What Causes Autoimmune Type 1 Diabetes?

Genetic factors

The exact cause of T1D is not fully understood. Current evidence suggests a combination of genetic and environmental factors. Read more about the common misconceptions and myths in the diagnosis of diabetes. Some people inherit genes that increase their likelihood of developing autoimmune conditions, including T1D. However, having these genes does not mean the condition will definitely occur.

Environmental triggers

Environmental factors are believed to play a role in triggering this autoimmune response, although the exact causes are not fully understood. These include:

• Viral infections
• Changes in the gut microbiome, which may affect immune regulation
• Early‑life environmental exposures that influence immune system development
• Other unknown environmental factors

However, these factors are not direct causes of T1D. Importantly, type 1 diabetes is not caused by diet, lifestyle, weight, or personal behaviours, and it cannot be prevented through lifestyle changes.

Long‑Term Health Problems
Over many years, high blood sugar can affect different parts of the body, such as:

• the eyes
• the kidneys
• the heart
• the nerves

These problems do not happen straight away and do not affect everyone. With regular care, check‑ups, and support, many people with Type 1 Diabetes stay well and active.

Difference between Type 1 and Type 2 Diabetes?

Type 1 Diabetes happens when the body's immune system mistakenly attacks the cells that make insulin, it usually starts in childhood but can happen at any age. Type 2 Diabetes is much more common and occurs when the body struggles to use insulin properly, often due to factors like weight, diet, and physical activity levels. The biggest difference is that Type 1 can't be prevented or reversed, while Type 2 can often be managed and sometimes even improved through healthier lifestyle choices and medication.

Early Detection Could Help you Get Ahead of T1D

Early Detection of Type 1 Diabetes Can:

• Gives you and your family valuable knowledge and time. Being identified earlier could help give you more time to understand the condition and reducing the stress and anxiety of a sudden diagnosis.
• May help reduce severe illness at diagnosis. Research studies have shown lower rates of severe illness such as diabetic ketoacidosis (DKA) at diagnosis among children and adults identified through early‑detection research programmes.

How Does Early Detection Work?

• The main method used in research is autoantibody screening. Autoantibody screening is used to identify immune markers that appear before symptoms of Type 1 Diabetes develop.
• Autoantibodies are markers made by the immune system when it mistakenly targets the body’s own insulin‑producing cells. These markers reflect an autoimmune response and are central to understanding early‑stage Type 1 Diabetes.
• Finding certain combinations of autoantibodies can indicate a higher likelihood of developing T1D in the future. Research shows that the presence of multiple diabetes‑related autoantibodies is strongly associated with progression toward clinical Type 1 Diabetes.

Decision Aid: Should I Consider Early Detection?

Early Detection for T1D is currently available in the UK through research programmes and not part of routine NHS care or a screening programme. This short decision aid may help individuals consider whether Early Detection could be relevant to them:

You may wish to explore screening if any of the following apply:

• You have a parent, sibling or child with autoimmune T1D.
• You have a second‑degree relative (grandparent, aunt, uncle or cousin) with autoimmune T1D.
• You or a family member has another autoimmune condition (e.g., coeliac disease, autoimmune thyroid disease).
• You have been diagnosed with diabetes as an adult and would like to understand whether it may be autoimmune in nature.
• You have no family history but are interested in understanding your risk within a research setting.

Early Detection does not diagnose diabetes. It identifies autoantibodies that may indicate an autoimmune process. Participation in research programmes is voluntary and doesn't replace routine NHS care.

If you are concerned about diabetes or its symptoms, please speak to your healthcare professional.

https://www.testfortype1.com/uk/what-is-autoimmune-type-1-diabetes

More moderate to vigorous physical activity could reduce type 2 diabetes risk

From medicalnewstoday.com

• Recent research suggests that higher levels of moderate-to-vigorous physical activity (MVPA) may more effectively reduce the risk of type 2 diabetes compared with lower MVPA levels.
• These findings were strongest in adults 62 years or younger, though older adults still saw benefits in reducing the risk.
• Experts advise that aerobic exercise and resistance training can be beneficial in helping reduce the risk of type 2 diabetes and manage prediabetes.

Physical inactivity is a known risk factor for type 2 diabetes. There are around 40 million people in the United States with some type of diabetes, and type 2 diabetes accounts for around 90% to 95%Trusted Source of all diabetes cases.

Type 2 diabetes can develop if the body does not make enough insulin or if it does not respond to insulin correctly. Overweight, age, and conditions such as prediabetes and metabolic dysfunction-associated steatotic liver disease (MASLD) are also risk factors.

New research published in August in Diabetes, Obesity and MetabolismTrusted Source suggests that moderate-to-vigorous physical activity (MVPA), in particular, could help reduce the risk of type 2 diabetes in adults.

The researchers examined data from almost 88,000 participants in the UK Biobank. They found that individuals in the lower-MVPA group had twice the relative risk of developing type 2 diabetes compared with those in the higher-MVPA group.

The largest relative risk reduction was observed in adults under 63 years of age.

Higher levels of moderate-to-vigorous physical activity could help reduce the risk of type 2 diabetes, according to recent research. GCShutter/Getty Images

Higher MVPA could significantly reduce risk of type 2 diabetes

With a hazard ratio of 2.07, lower MVPA volume was associated with almost twice the risk of type 2 diabetes compared with higher MVPA volume.

The higher MVPA group accumulated a median of 409 minutes of exercise per week. The study authors note that all participants in this group met the World Health Organization (WHO)’sTrusted Source guidelines of at least 150 minutes of moderate aerobic activity per week.

The lower MVPA group accumulated a median of 121 minutes of exercise per week. Around 37% of participants in this group reached the WHO’s minimum recommendation of 150 minutes per week.

Opel Baker, MBChB, general practitioner at the Mayfield Clinic, spoke with Medical News Today about the significance of these findings.

“An HR of 2.07 is clinically meaningful. […] Importantly, this is an observational study, so it shows a strong association rather than proving that lower activity directly caused diabetes,” said Baker, who was not involved in the study.

“Nevertheless,” Baker added, “it reinforces something we see in general practice: physical activity is one of the most powerful and accessible tools we have for improving insulin sensitivity and reducing diabetes risk.”

David Cutler, MD, board certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, who was also not involved in the study, told MNT:

“An HR of 2.07 doesn’t mean that an individual person’s probability of diabetes literally doubles. It means that the rate of developing diabetes was approximately twice as high in the lower-activity group after adjustment.”

He added, “This data reinforces the message that physical activity isn’t merely a treatment for diabetes — it is an important component of diabetes prevention. This is not new information. Regular exercise improves insulin sensitivity, helps control visceral fat, improves skeletal-muscle glucose uptake, and favourably affects lipid metabolism.”

Adults 62 years or younger saw greatest risk reduction

The study found that the relationship between physical activity levels and type 2 diabetes was stronger among younger adults.

Compared with people who had higher levels of MVPA, those aged 62.7 years or younger with lower levels of MVPA were 2.44 times more likely to develop type 2 diabetes.

Among adults aged 62.7 or older with low MVPA, they were 1.65 times more likely to develop the condition.

‘One of the most interesting findings in this study is the impact of age on the benefits of moderate-to-vigorous physical activity,” said Cutler.

“At first glance, the lower HR (hazard ratio) in older participants (1.65 vs 2.44 in younger participants) might suggest exercise is less beneficial in the elderly. But those numbers can be misleading. The authors found that, although the relative association became weaker with age, the absolute difference in diabetes incidence became larger with age. That’s an important clinical distinction.”

Baker also spoke with MNT about these findings.

“What I find particularly interesting is that the relationship wasn’t identical across different age groups. The relative association between lower activity and diabetes risk was stronger in younger participants. […] But that doesn’t mean exercise becomes less important as we age,” he said.

“In fact, the absolute difference in diabetes rates between the more and less active groups became larger with age. It suggests that staying active throughout life may be particularly important because baseline diabetes risk rises with age. It is never too late to become more active,” he added.

Prediabetes management with higher MVPA

The study authors note that higher MVPA volume was associated with a lower risk of type 2 diabetes among people with prediabetes.

Baker said that exercise with prediabetes should be thought of as “management rather than simply prevention.”

He explained that “exercise improves insulin sensitivity, meaning the body becomes better at using glucose. For someone with prediabetes, increasing activity can therefore help bring blood glucose back toward the normal range and reduce progression to type 2 diabetes.”

He added, “The important point is that there isn’t necessarily a completely different exercise prescription for someone with prediabetes. The starting point should be realistic and sustainable, then gradually built up according to the person’s fitness, health, and goals. Strength training is also valuable because maintaining and building muscle helps with glucose disposal.”

Does the exercise type and duration matter?

The research did not focus on the type of exercise. Instead, it looked at the intensity of the workouts, with greater amounts of moderate to vigorous physical activity generally yielding stronger results.

Cutler advises that, “[f]or diabetes prevention, there is good rationale for combining aerobic exercise (brisk walking, cycling, swimming, jogging, hiking) with resistance exercise (weights, resistance machines, bands, body weight exercises).”

He added that “resistance exercise is particularly interesting because skeletal muscle is a major site of glucose disposal. Increasing or maintaining muscle mass and improving muscle insulin sensitivity can therefore be metabolically important.”

The study authors found that participants in the higher MVPA group had a median of 409 minutes of exercise each week, compared with 121 minutes in the lower MVPA group.

We asked Baker how achievable these numbers are for the average person compared with the WHO’s recommendation of 150 to 300 minutes of moderate aerobic activity per week for optimal health and well-being.

“I wouldn’t want people to look at the 409-minute figure and think they have failed if they aren’t exercising for nearly seven hours a week. That was the median activity level of the higher-MVPA group in this particular study, not a recommended target,” Baker explained.

“The researchers also defined their higher and lower activity groups according to the age-specific median, rather than using 409 minutes as a clinical threshold. For the average adult, 150 minutes of moderate activity a week remains a very sensible and achievable target, alongside muscle-strengthening activity on at least two days."

https://www.medicalnewstoday.com/articles/more-moderate-to-vigorous-physical-activity-could-reduce-type-2-diabetes-risk